Tonsillitis

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Introduction

  • An inflammatory condition of the palatine tonsils, common in children
  • In half or more cases infection is by beta-haemolytic streptococcus, in others viral
  • Typically an acute infection
  • Chronic tonsillitis presents usually as recurrent acute infection
  • Essentially a disease of children but also occurs in young adults

Clinical features

  • Fever
  • Sore throat
  • Dysphagia
  • Systemic upset and malaise
  • Tonsils are swollen, inflamed and covered with purulent exudates
  • Jugulo-digastric lymph nodes are enlarged and tender

Differential diagnoses

  • Infectious mononucleosis
  • Vincent's angina
  • Agranulocytosis

Complications

  • Quinsy: main common complication
  • Parapharyngeal infection/abscess
  • Rheumatic fever and nephritis following streptococcal tonsillitis

Investigations

  • Throat swab for microscopy, culture and sensitivity
  • Full Blood Count

Treatment goals

  • Control the infection
  • Control pain
  • Prevent further episodes

Non-drug treatment

  • Oral hydration
  • Salt/warm water gargle
  • Tonsillectomy in chronic cases with frequent recurrent tonsillitis

Drug treatment

  • Antibiotics
    • Amoxicillin
      • Adult: 250 - 500 mg orally 8 hourly for 5 - 7 days
      • Child: 40 mg/kg orally every 8 hours for 5 - 7 days
      • The parenteral route may be required when there is vomiting or severe dysphagia
    • Or:
    • Cotrimoxazole
    • Adult: 960 mg orally 12 hourly for 5 - 7 days
    • Child
      • 6 weeks to 5 months: 120 mg orally 12 hourly;
      • 6 months - 5 years: 240 mg 12 hourly
      • 6 – 12 years: 480 mg every 12 hours
  • Analgesic
    • Paracetamol
    • Adult: 500 mg -1 g orally 4 - 6 hourly (to a maximum of 4 g) for 5 - 7 days
    • Child
      • over 50 kg: same as adult dosing
      • 6 - 12 years: 250 - 500 mg;
      • 3 months - 5 years:125-250 mg taken orally 4 - 6 hourly for 5 - 7 days

Supportive measures

  • Bed rest
  • Intravenous infusion as necessary

Notable adverse drug reactions, contraindications, and caution

Cotrimoxazole

  • Fixed drug eruption
  • Nausea and vomiting
  • Erythema multiforme
  • Steven-Johnson syndrome